Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs
Surgical Endoscopy,

Roy A et al. – While the technical and clinical outcomes of surgical GJ and endoscopic stenting appear comparable, stent placement is less costly and is associated with shorter length of hospital stay. Dissemination of endoscopic stenting beyond teaching, academic hospitals located in urban areas as a treatment for malignant GOO is important given its implications for patient care and resource utilization.

Methods
  • A retrospective claims analysis of the Medicare (MedPAR) database was conducted to identify all inpatient hospitalizations for GJ or endoscopic stenting for malignant GOO during 2007–2008.
  • The main outcome measure evaluated using the MedPAR database was a comparison of the total length of hospital stay (LOS) and costs associated with both techniques.
  • As MedPAR is a claims database that does not provide outcomes at patient level, a single–institution retrospective study was conducted to compare the rates of technical and treatment success, post–procedure LOS, and delayed complications per patient between the two techniques.

Results
  • The MedPAR claims data evaluated 425 stenting and 339 GJ hospitalizations.
  • Compared with GJ, median LOS (8 vs. 16 days; p < 0.0001) and median cost (US 15366vsUS 27,391; p < 0.0001) per claim were both significantly lower for stenting.
  • Stenting was more commonly performed at urban versus rural hospitals (89 % vs. 11 %; p < 0.0001), teaching versus non–teaching hospitals (59 % vs. 41 %, p = 0.0005), and academic institutions (56 % vs. 44 %; p = 0.0157).
  • The institutional patient data analysis included 29 patients who underwent stenting and 75 who underwent surgical GJ.
  • While both modalities were technically successful and relieved gastric outlet obstruction in all cases, compared with surgical GJ, the median post–procedure LOS was significantly lower for enteral stenting (1.5 vs. 10.7 days, p < 0.0001).
  • There was no difference in rates of delayed complications between stenting and surgical GJ (13.8 % vs. 6.7 %; p = 0.26).

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Surgery

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Surgery Articles

1 Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: A single center experience with 2 years follow-up Obesity Surgery, August 8, 2014    Clinical Article

2 Long intestinal tube splinting really prevent recurrence of postoperative adhesive small bowel obstruction? A study of 1071 cases The American Journal of Surgery, July 23, 2014    Clinical Article

3 Metabolic effects of large-volume liposuction for obese healthy women: A meta-analysis of fasting insulin levels Aesthetic Plastic Surgery, August 19, 2014    Evidence Based Medicine    Review Article

4 Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence Obesity Surgery, August 4, 2014    Evidence Based Medicine

5 Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study with 5 years of follow-up Obesity Surgery, July 14, 2014    Clinical Article

6 Comparison of marginal ulcer rates between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass Obesity Surgery, August 7, 2014    Clinical Article

7 The effect of PPI use on human gut microbiota and weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass Obesity Surgery, August 13, 2014    Clinical Article

8 Abdominoplasty-derived dermal-fat graft augmentation gluteoplasty Aesthetic Surgery Journal, August 25, 2014    Review Article
Exclusive Author Commentary

9 Complications of bariatric surgery: Dumping syndrome, reflux and vitamin deficiencies Best Practice & Research Clinical Gastroenterology , August 1, 2014    Clinical Article

10 Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up International Journal of Surgery, August 26, 2014    Clinical Article

11 Short- and long-term outcomes of LigaSure versus conventional surgery for curative gastric cancer resection: a matched pair analysis Gastric Cancer, August 22, 2014    Clinical Article

12 Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction The Journal of Trauma and Acute Care Surgery, June 9, 2014    Evidence Based Medicine    Clinical Article

13 Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment Current Gastroenterology Reports, August 20, 2014    Clinical Article

14 DermACELL: a novel and biocompatible acellular dermal matrix in tissue expander and implant-based breast reconstruction European Journal of Plastic Surgery, August 14, 2014    Clinical Article

15 Laparoscopic versus robotic Roux-en-Y gastric bypass: Lessons and long-term follow-up learned from a large prospective monocentric study Obesity Surgery, July 1, 2014    Clinical Article

16 Correlation between the gastrojejunostomosis area, documented endoscopically, and the loss of weight in laparoscopic gastric bypass postoperative patients: Results of 1 year after surgery Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, August 11, 2014    Clinical Article

17 Laparoscopic versus open low anterior resection for rectal cancer: results from the National Cancer Data Base Journal of Gastrointestinal Surgery, August 11, 2014    Clinical Article

18 Primary sleeve gastrectomy compared to sleeve gastrectomy as revisional surgery: weight loss and complications at intermediate follow-up Journal of Gastrointestinal Surgery, August 15, 2014    Review Article

19 Closed-tube thoracostomy: A novel emergency surgery technique Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, August 20, 2014    Clinical Article

20 Two stages conversion of failed laparoscopic adjustable gastric banding to laparoscopic Roux-en-Y gastric bypass. A study of one hundred patients Journal of Gastrointestinal Surgery, August 6, 2014    Clinical Article

Indexed Journals in Surgery: Surgery, Journal of the American College of Surgeons, Annals of Surgerymore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close